Morning Report: Tumor Lysis Syndrome

This Morning Report is brought to you by Dr. Bonnie Brown

Tumor Lysis Syndrome

What is TLS?

Oncologic emergency caused by the massive lysis of tumor cells, most frequently after initiation of cytotoxic therapy (chemotherapy, steroids, radiation) but can be spontaneous

Who is at risk?
- “Liquid” malignancies (leukemias, lymphomas)
- Recent chemotherapy (6-72 hr)
- High tumor burden, tumors with rapid turnover
- Pre-existing renal impairment
- Meds that increase uric acid (aspirin, thiazides, levodopa,methyldopa,caffeine, alcohol)

Complications:
- Metabolic derangements
- - Hyperkalemia
  - Hyperuricemia
  - Hyperphosphatemia
  - Hypocalcemia
- Renal failure
- Arrhythmia, sudden death
- Seizure
Treatment-
- Fluids–> increase urinary output, “wash out” crystals in tubules
- Correct electrolyte abnormalities, may necessitate emergent dialysis
- Rasburicase dose : 0.2mg/kg (14mg for 70kg pt)
- Sevelamer phos binder of choice

Sources:
Tumor Lysis Syndrome- Prevention and Treatment. http://www.uptodate.com/contents/tumor-lysis-syndrome-prevention-and-treatment?source=outline_link&view=text&anchor=H21712175#H21712175
British Guidelines for Management of TLS. http://www.bcshguidelines.com/documents/Tumour_Lysis.pdf